A national study on conditional survival, excess mortality and second cancer after high dose therapy with autologous stem cell transplantation for non-Hodgkin lymphoma.

This national population-based study aimed to investigate conditional survival and standardized mortality ratios ( SMR) after high-dose therapy with autologous stem-cell transplantation ( HDT- ASCT) for non-Hodgkin lymphoma ( NHL), and to analyse cause of death, relapses and second malignancies. All patients ≥18 years treated with HDT- ASCT for NHL in Norway between 1987 and 2008 were included ( n = 578). Information from the Cause of Death Registry and Cancer Registry of Norway were linked with clinical data. The 5-, 10- and 20-year overall survival was 61% (95% confidence interval [ CI] 56-64%), 52% (95% CI 48-56%) and 45% (95% CI 40-50%), respectively. The 5-year survival conditional on having survived 2, 5 and 10 years after HDT- ASCT was 81%, 86% and 93%. SMRs were 12·3 (95% CI 11·0-13·9), 4·9 (95% CI 4·1-5·9), 2·4 (95% CI 1·8-3·2) and 1·0 (95% CI 0·6-1·8) for the entire cohort and for patients having survived 2, 5 and 10 years after HDT- ASCT respectively. Of the 281 deaths observed, 77% were relapse-related. Treatment-related mortality was 3·6%. The 10-year cumulative incidence of second malignancies was 7·9% and standardized incidence ratio was 2·0 (95% CI 1·5-2·6). NHL patients treated with HDT- ASCT were at increased risk of second cancer and premature death. The mortality was still elevated at 5 years, but after 10 years mortality equalled that of the general population. [ABSTRACT FROM AUTHOR]